Behavioral Supervised Living

Behavioral Supervised Living A. Behavioral Supervised Living is not a separate service than Supervised Living Services, but allows an increased reimbursement rate for persons enrolled in the ID/DD Waiver with significant behavioral issues who require one-on-one (1:1) staffing at all times. Additional eligibility requirements for persons who receive this level of support and requirements for Supervised Living Services settings to receive the increased reimbursement rate are outlined in this section. (Rule 30.1 – Supervised Living Services for people with Intellectual/Developmental Disabilities service components and Chapter 13 for Environment and Safety for Supervised Living Services for people with Intellectual/Developmental Disabilities applies to Behavioral Supervised Living. B. Behavioral Supervised Living provides a level of service intended to support people with high frequency disruptive behaviors that pose serious health and safety concerns to self or others, including destructive behaviors that may or will result in physical harm or injury to self or others. To receive Behavioral Supervised Living, there must be a documented history of the behavior(s) listed below that is likely to reoccur without supervision and structure in the person’s living arrangement. Behavioral Supervised Living must receive prior approval by DMH. C. To provide Behavioral Supervised Living, a provider must first be approved to do so by DMH. The following must be submitted through the Division of Certification: 1. Documentation and procedures to ensure the required team members are available to perform required duties. Refer to Chapter 11. 2. Documentation and procedures for how the team will address requirements for each Behavioral Supervised Living site. 3. Documentation and procedures describing that all staff in each approved home have the required training. 4. Documentation and procedures describing how trained staff coverage for the home, dependent upon the needs of the person/people receiving Behavioral Supervised Living and others who may be living in the home, will be provided. D. Documentation supporting that the person requires the level of support offered in Behavioral Supervised Living is gathered by the Supervised Living Services provider and Support Coordinator or Transition Coordinator and submitted to DMH for eligibility determination. E. Eligibility Criteria for each person includes a documented history of behavior(s) listed below that is likely to reoccur without supervision and structure in the person’s living arrangement: 1. A person who may or has caused great emotional harm to self or others; 2. Inability of a person to control behaviors to the extent it impedes their day-to-day functioning at home, in a community living arrangement, and/or at a day service; 3. The person engages in self-injurious behaviors that cause harm to self because of both internal and external stimuli; and 4. One-to-one (1:1) staffing hours are necessary to ensure the health and safety of the person and/or others. F. The Behavioral Supervised Living provider must consider compatibility with other people living in the home. The person receiving a higher level of support must not pose a threat to others living in the home. G. Continuous monitoring of the behaviors of each person receiving Behavioral Supervised Living is needed. The involvement of the Behavior Consultant and Behavior Specialist should fluctuate based on the needs of the person receiving Behavioral Supervised Living and the person’s response to behavior modification efforts. Once employees have been trained, and the identified person’s problematic behavior(s) begin to mitigate, the Behavior Consultant’s and Specialist’s involvement can decrease. If changes in the person’s problematic behavior(s) occur or increase, Behavioral Supervised Living personnel must return to the setting where the behaviors are occurring and either retrain employees or increase their involvement and evaluate the revised Behavior Support Plan as needed and retrain employees. One-on-one (1:1) direct care staff should be present at all times when a person is receiving Behavioral Supervised Living. 1. Documentation Requirements for Behavioral Supervised Living: (a) The Behavior Consultant must begin the Functional Behavioral Assessment (FBA) upon notification from the Support Coordinator that Behavioral Supervised Living has been approved for the person. The Functional Behavioral Assessment must be completed within 15 calendar days of the notification of approval for the person to begin Behavioral Supervised Living. The Behavior Support Plan must be completed within 15 calendar days of the completion of the Functional Behavioral Assessment. The Behavior Consultant must review and approve the Functional Behavioral Assessment and Behavior Support Plan. (b) Service Notes must reflect the person’s and the employee’s activities throughout the day, with at least one (1) entry every two (2) hours while the person is awake and in the home. Overnight entries can be every four (4) hours. (c) Data must be collected as directed by the Behavior Consultant. (d) There must be quarterly review reports that reflect the supports provided and the amount of progress made during each quarter. Based on data gathered during each quarter, the Behavior Consultant composes a report that reflects target behavior(s), medication changes, information about Behavior Support Plan implementation and narrative information about baseline data, data from the previous quarterly review report, and narrative information about the current quarter’s data. (e) The quarterly review report must include the next steps to be taken in implementation of the Behavior Support Plan. Next steps could include actions such as continuing with the Behavior Support Plan as it is written or modifying it to meet any changing needs. Modifications can be made to the intervention, intervention techniques, target behaviors, training needs, timelines, etc. (f) The Behavior Consultant must be available for consultation when adjustments to the Behavior Support Plan are needed. H. Provider responsibilities for services provided away from the Behavioral Supervised Living Home: The agency provider must be prepared to send employees with the person to day activities to ensure continuity for the person. The Behavior Consultant and/or Specialist must train employees wherever the person is during the day how to manage behavior(s) that are identified in the Behavior Support Plan, even if the agency provider of Day Services is different than the agency provider of Behavioral Supervised Living. As long as the person is in Behavioral Supervised Living, it is the responsibility of the agency provider to ensure the Behavior Support Plan is implemented. This can be done by the Behavior Consultant/Specialist or direct care personnel, depending on the situation. I. Ongoing Review of Need for Behavioral Supervised Living: 1. DMH will determine the need for ongoing Behavioral Supervised Living at least annually. 2. The following documentation must be submitted to the person’s Support Coordinator within 90 calendar days of the end of a person’s certification period. The Support Coordinator will submit the documentation to DMH within five (5) calendar days of receipt of all required documentation. All documentation must be received by the Support Coordinator at one time; partial submissions of required information will not be accepted. (a) Serious Incident reports (previous six [6] months). (b) Behavior reports (previous six [6] months). (c) Most current Functional Behavioral Assessment, which must be updated at least every two (2) years. (d) Most current Behavior Support Plan, which must be updated at least every two (2) years. (e) Quarterly Review reports (previous four [4] quarters). Quarterly Review reports should include numerical data or graphed data. (f) Any other documentation supporting the need for this service. J. Use of Other Behavior Services 1. People who receive Behavioral Supervised Living cannot also receive Behavior Support or Crisis Intervention Services. The goal is for the agency provider’s Behavioral Supervised Living Team to be able to resolve/mitigate issues/behaviors where the person lives/receives day services. Alternate living arrangements may be used for short-term purposes. 2. If the issue is determined to be a medication issue which requires medical intervention, Crisis Support may be considered. There must be adequate supporting documentation, and it must be approved by DMH. 3. Crisis Support should be the last resort.